Exploring the Business Case to Build, Sustain and Scale Private Insurer and Employer-Funded Produce Prescriptions: A Food as Medicine Financial Modelling Pilot

Background:

Beginning around 2010, a movement that came to be known as Food as Medicine (FAM) began addressing food insecurity and diet-related health conditions for patients by connecting them to healthy food & nutritional support by way of a healthcare provider’s “prescription”. Many FAM studies and reports illustrate direct improvements in health outcomes as well as cost savings and efficiencies. However, the programming, research and evaluation to-date have almost exclusively addressed Medicaid, Medicare, or SNAP-eligible populations, and the evaluation metrics related to the economics of the interventions have been defined through a public health and societal lens.

While these are critical groups to support with FAM, diet-related health conditions and associated healthcare costs affect a broader population. With the nation at large seeing unprecedented levels of diabetes, cardiovascular disease, and food insecurity and direct healthcare costs associated with diet-related health conditions estimated at $650 billion/year (calculated from Deuman et al, True Cost of Food Tufts 2023 report) there is an opportunity for private insurers to address widespread diet-related health conditions while also improving their bottom line.

This project implements a pilot and randomized trial to make a business case for private health insurers and employers to deploy FAM programs, specifically Produce Prescription (PRx), as a benefit for plan members and employees.

Different from previous FAM programs and studies, this pilot will leverage PRx for employed and privately insured individuals, and metrics for analysis will be defined by what is important for private insurer and employer decision-making. Through this project, Buffalo Go Green, an agricultural and wellness non-profit; one of NY’s largest health insurers, Highmark BCBS of Western NY (Highmark); one of NY’s largest healthcare providers, Kaleida Health; and Cornell’s Figueroa Interdisciplinary Group (FIG) Lab; will bring FAM program design and implementation expertise, field expertise, data access, and the synthesis tools and specialization critical for unprecedented evaluation of the private sector’s role in the field. With these collaborators, the decision-making model developed as a part of the pilot and the evaluation of the pilot will reveal long-awaited evidence for the business case for a private insurer and an employer, as well as the associated health outcomes for a privately insured, employed, lower wage population.

The pilot program will provide a PRx varying from 8 weeks, 12 weeks, 18 weeks and 6 months of weekly healthy food distributions, nutrition education and wrap-around support – to 250 lower wage Kaleida Health employees enrolled in Kaleida’s Highmark plan. Approximately 65% of staff eligible by income limitations are people of color. Narrowing of the diet-related health conditions for eligibility will be determined by the project collaborators in the project’s Set-Up phase.

Planned Activities:

There are 3 distinct project phases: 1) Set-Up, 2) Implementation, and 3) Data Analysis + Evaluation. During Set-Up, collaborators will finalize pilot design, solidify evaluation metrics, build evaluation tools, establish eligibility criteria, stand up enrollment processes, roll out communications and data sharing protocols and practices, and get IRB approval. Then, participants will be enrolled. During Implementation, food delivery and nutrition education will be delivered, and data identified during the Set-Up phase will be collected and tracked. Anticipated metrics based on early collaborator conversations and best practices.

Goals + Outcomes:

Goal 1: Develop healthy partnerships, program design, and systems that effectively link a large Buffalo employer (Kaleida Health), one of the largest NYS private insurers (Highmark), and a food access community-based organization (Buffalo Go Green) in an operationally and financially sustainable Food as Medicine model.

Outcome 1: Strong FAM intervention design, partnerships and workflows established during the project serve as foundation for ongoing FAM offerings not reliant on philanthropic dollars.

Goal 2: Identify feasible metrics to collect and finalize the design of the financial model to calculate the business case for the private insurer and employer.

Outcome 2: Identified metrics and financial model serve as foundation for ongoing FAM offerings not reliant on philanthropic dollars.

Goal 3: Run a FAM intervention and data collection period for a series of cohorts, representing different FaMRx “dose” amounts – cohorts will receive either an 8 week, a 12 week, 18 week and 6 month intervention that will include weekly produce Rx boxes; a set amount of 8 weeks of cooking and nutrition lessons will be required and can be accessed in person and virtually..

Outcome 3: Households receiving FAM intervention as a part of the project see improved health outcomes, reduced healthcare expenses and reduced costs to their employer.

Goal 4: Analyze the outcomes for the pilot’s return on investment for the private payer and the employer, establishing confidence in the development of a FAM model not reliant on philanthropic dollars.

Outcome 4: Outcomes illuminate an intervention model and Healthcare and Employer partners determine cost model (Private insurance participation (%) of the total provision of healthy food, Employer co-payment, Employee co-payment) that allows for ongoing offerings not reliant on philanthropic dollars.

Purpose and goals of the research:

This project aims to evaluate the feasibility and effectiveness of participating in an 8 week to 6 month produce prescription program on health behaviors and food security.

How will this study contribute to existing knowledge? Over 60% of United States adults are estimated to be diagnosed with one or more diet-related chronic conditions (e.g., type 2 diabetes). Produce prescription (PRx) programs are promising interventions to increase access to nutritious foods, however, there is a critical need to establish implementation success and real-world effectiveness to inform future scalability of these efforts. This study will provide evidence on the feasibility and effectiveness of produce prescription programs in the workplace context.

Implementation:

This 8 week- 6 month PRx program includes nutrition education sessions (8 weeks of classes) and weekly fruit and vegetable distributions. Mandatory Nutrition/Cooking education will be conducted In person and/or virtual sessions through the 8-week PRx implementation. All sessions will be recorded. Participants are required to complete at least 80% of nutrition education. Sessions will discuss topics such as eating healthy on a budget, cooking and recipe demonstrations, among others. Upon establishing consent to participate, participants will complete a pre-survey on paper or Qualtrics. Midway through intervention participants will complete a midpoint survey. At the end of the program participants will be asked to complete a post-survey on paper or Qualtrics.

Lesson Outlines:

Nutrition Facts Label

• How to read label including ingredients
• Identifying Macronutrient, serving size
• 5/20 easy trick
• Deciphering package labels (“Heart healthy”, “Whole Grain”) (Name brands vs. store bought)
• How to use nutrition label while shopping

Healthy Snacking

• How to pair snacks (example protein w/carb)
• Choose Nutrient dense foods
• Be mindful of portion sizes
• Limit processed foods and sugary beverages
• Plan ahead
• Examples

Plant Based Eating

• Plant based protein
• Different plant based diets and their definitions                vegan/vegetarian/lacto ovo, ovo/ pescatarian/flexitarian etc.
• Benefits of plant based eating
• Building a balanced plant based meal
• Keeping plant based eating affordable

Healthy on a Budget

• How to stretch a dollar on whole foods vs. fast foods with examples
• Meal Planning- Free time to plan
• Fresh/Frozen: Incorporating frozen/canned/dried (beans/lentils/tuna/chicken)
• Staple pantry items
• Generic vs store brand on a budget
• Setting food budget
• Incorporating seasonal produce/supporting local farmers markets
• How food stories relate to staple pantry items, fresh v frozen, farmers markets